Update on contraindications in laser corneal refractive surgery.

Area of Science:

• Ophthalmology
• Refractive Surgery
• Corneal Biomechanics

Background:

• Over 25 years of experience and technological advances have established laser corneal refractive surgery as safe and effective.
• Continued research into refractive errors, higher-order aberrations, and corneal biomechanics enhances understanding.
• Despite advancements, specific contraindications and potential complications require careful consideration.

Purpose of the Study:

• To review current contraindications for laser corneal refractive surgery.
• To analyze contraindications based on American Academy of Ophthalmology and Spanish Ophthalmology Society Preferred Practice Protocols (PPPs).
• To improve the safety profile of refractive surgery by providing clear recommendations.

Main Methods:

• Analysis of current contraindications for laser corneal refractive surgery.
• Review of Preferred Practice Protocols (PPPs) from the American Academy of Ophthalmology and the Spanish Ophthalmology Society.
• Differentiation of contraindications into absolute and relative categories.

Main Results:

• Absolute contraindications include age under 18, lack of refractive stability, certain ocular pathologies (e.g., keratoconus, severe dry eye), and uncontrolled systemic diseases (e.g., autoimmune, diabetes).
• Relative contraindications include specific medications (amiodarone, isotretinoin), extreme keratometry/pachymetry values, history of uveitis/glaucoma, pregnancy, and lactation.
• Some studies suggest refractive surgery may be safe in certain cases currently considered relative contraindications.

Conclusions:

• Adherence to established protocols for contraindications is crucial for safe laser corneal refractive surgery.
• Careful patient selection based on absolute and relative contraindications maximizes surgical safety and efficacy.
• Ongoing research may refine guidelines for refractive surgery in cases with previously considered contraindications.